Planning for Radiation Treatment

Your First Visit

If radiation treatment is an option, a visit will be scheduled with a radiation oncologist at the Ruth and Raymond Perelman Center for Advanced Medicine.

This first visit is to:

Decide on the use of radiation treatment

Determine the kind of radiation treatment

Answer any questions you may have

On this first visit, you may be asked to bring X-rays, laboratory tests, and pathology slides for the radiation oncologist to review. Depending on your situation, the visit will take one to several hours. During the visit, a history and physical exam will be done by the radiation oncologist. The radiation oncologist may also discuss their findings with other members of the team, such as your medical oncologist at CHOP. This is to make sure that your child receives the best possible care.

At the end of the visit, your doctor will review the role of radiation treatment. If radiation therapy is to be given, all treatments will be in the Radiation Oncology Department at the Perelman Center.

Informed Consent Process

If radiation treatment is to be given, the doctor will review the plan, the reasons for the treatment, and the possible risks and side effects. There will be plenty of time during this visit for you to understand the treatment and related issues. All of your questions and concerns will be answered.

It is a good idea to bring a family member or friend with you to this first visit. It can be difficult to remember everything the doctor says or to know every question to ask. Family and friends may be able to help you during the visit and have their own questions answered.

You will be asked to sign a consent form once you have a full understanding of the treatment including:

How the treatment will be given

Possible risks and side effects

Other treatment options

Before you sign the consent form, it is important that you are comfortable with the information that you have been given. Your signature means that you have received the information and that you are willing to have your child treated with radiation.

Even after you have signed the consent, your doctor is always there to answer new questions or to give more information. You can withdraw your consent at any time, for any reason.

Simulation

Before Treatments Begins

There will be a process called "simulation" or "sim," for short.

"Simulation" confirms the exact location on the body. This location is called the treatment field.

A machine called a "simulator" is used. The "simulator" mimics the movements and settings on the actual treatment machine that will be used to give the radiation treatment.

The machine that actually gives the treatments is called a linear accelerator. During the "simulation", X-rays or CT (computerized tomographic) scans will be taken.

Before "Simulation"

Your therapist will show you and your child the room with the "simulator." They will also tell you about what will happen.

The therapist will also review with you and your child how to communicate with the therapist if your child should need anything during the process.

Seeing the room ahead of time and talking with the therapist will help you all to feel more comfortable.

You will be able to go with your child to the room and stay with them until they are on the table. Then you will return to the waiting room.

During "Simulation"

The treatment team is able to see and communicate with your child at all times.

The entire "simulation" takes about an hour. However, this may vary.

Since your child will be lying on a hard table, they may have some pain or discomfort. The therapist will check with your child often. Adjustments can be made to relieve discomfort and a doctor or nurse can provide medication to relieve pain.

Keep in mind that the "simulation" takes longer than the actual treatments. If your child needs you for any reason, the therapist will let you know.

In some cases, the CT scanner is used along with "simulation" to help plan the treatments. When this is done, the CT scans are taken in the Radiation Oncology Department at the Perelman Center a few days before "simulation." Information from the CT scan is used to find the treatment area. The CT scanner is designed to work with the other radiation equipment. These scans are not a replacement for other diagnostic scans that may have been done.

For some, a special piece of equipment called an "immobilization device," will be made. This device will help to position your child during treatment.

At the end of "simulation," the therapist will give you instructions for your next appointment.

Tattoos

At the end of the simulation visit, it may be necessary to put marks —called tattoos — on your child. This is to show the treatment area. Thesemarks will be very small and not that noticeable. They are dots, about thesize of a pinpoint or freckle. They are made using India ink. Not everyoneneeds tattoos.

Placing the tattoos may cause some discomfort. The discomfort willnot last long. The tattoos are permanent, they won't ever go away. Havingthe tattoos allows for bathing without having to worry that the marks willwash off.

Technical Planning Process

After simulation and before treatment begins, the information is sent to radiation dosimetrists and medical physicists. These specialists perform highly technical calculations to set the treatment machine.

Set-Up

After the simulation and all the calculations have been done, you willhave your "set-up" and then treatment can begin. Set-up is the process ofgetting your child situated on the actual machine where their treatmentwill be given. The treatment machines (linear accelerators) look like thesimulator, but are larger. Your child will be placed on the table, in thesame position they were in during simulation. A set of images will betaken. These will be checked by your therapist and doctor.

After set-up, the therapist will talk with you about the daily treatmenttime. If your child is going to have general anesthesia, the treatment willbe first thing in the morning. If your child is not having anesthesia go topage 12. If your child is having anesthesia it is important that you readthe instructions for General Anesthesia.